Let Us Show You How Firstpass Can Help

FirstWatch customer Chuck Walker, Clinical Services Coordinator for Sunstar Paramedics, uses FirstPass to enhance their QI process

FirstPass Customers:

Advanced Medical Transport, IL – Alachua County Sheriff’s Office, FL – Allina Health EMS, MN – AMR EMSA, OK – AMR Portland, OR – AMR San Bernardino, CA – AMR San Diego, CA – AMR Santa Barbara, CA – AMR Santa Clara, CA – AMR Ventura, CA – Anchorage Fire, AK – Austin Travis County EMS, TX – Baltimore City Fire, MD – Brewster Ambulance Service, MA – Broken Arrow Fire, OK – Care Ambulance-OC, CA – Charles County EMS, MD – Clark County Fire Department, NV – Community Ambulance, GA – Community Ambulance, NV – Contra Costa County EMS and Fire, CA – Cy-Fair Volunteer Fire, TX – Cox Health, MO – CRESA-Vancouver AMR, WA – CRESA-Vancouver Fire, WA – DC Fire and EMS, DC – Durham County EMS, NC – Eastside Fire & Rescue, WA – Falck, Northern CA – Falck, Northwest CA – Falck Rocky Mountain, CA – Falcon Ambulance, CA – FDNY, NY – Greenfield Fire Department, WI – Guilford County EMS, NC – Hackensack UMC EMS, NJ – Hawaii County, HI – Huntsville Emergency Medical Services, AL – Jersey City EMS, NJ – JFK EMS, NJ – Johnson County MedAct, KS – Lake EMS, FL – Las Vegas Fire Rescue, NV – Lassen County EMS, CA – Life EMS, MI – LifeCare Ambulance, MI – LifeNet EMS, TX – Louisville Metro EMS, KY – MAAS, GA – Marion County, GA – McCormick Ambulance, CA – MedStar, Fort Worth, TX – Mercy Medical Transportation, CA – Modesto Fire, CA – MONOC, NJ – Montgomery County FRS, MD – Mountain Valley-AMR, CA – Mountain Valley-Oak Valley, CA – Mountain Valley-Patterson District, CA – Mountain Valley-Pro-Transport, CA – Mountain Valley-West Side, CA – Nature Coast EMS, FL – New Hanover EMS, NC – Niagara EMS, Ontario, Canada – NorCal Ambulance, CA – North Shore Fire Rescue, WI – Northwell Health, NY – Orange County Fire & EMS, VA – Pinellas County, FL – Prince George's County Fire/EMS, MD – ProEMS, MA – REMSA, NV – Richmond Ambulance Authority, VA – Riggs Ambulance/SEMSA, CA – Robert Wood Johnson, NJ – San Marcos Hays County, TX – San Mateo County EMS, CA – SCCAD, MD – Sedgwick County EMS, KS – SNOPAC 911, WA – Solano County-Medic Ambulance, CA – Sonoma, CA – Spokane Fire, WA – Trinity EMS, MA – Tucson Fire Department, AZ – UC Health EMS, CO – WestMed Ambulance, CA – Williamson County EMS, TX – Winnipeg Fire Paramedic Service, Manitoba, Canada

LET US SHOW YOU HOW FIRSTPASS CAN HELP.

Know what’s Collaborate among Review quality Analyze system happening in your stakeholders within indicators most and individual system to make one view important to you protocol compliance improvements now The traditional approach to Quality Improvement in EMS is labor intensive, time consuming and often confusing, A word from our leaving little time to actually improve care. EMS agencies What is need the ability to monitor and analyze patient care Improvement Guide data, identifying deviations rapidly, consistently and FirstPass? automatically. Almost every EMS system has something with the word FirstPass® is a Performance Improvement system that quality in it: a quality plan, a peer review QI committee makes it easy for you to see your systems overall or a quality improvement manager. Yet when you ask performance for clinical care and billing. It helps you EMS leaders what their quality program has made quickly identify big areas that need improvement and better, shoulders shrug and the subject changes. then helps you figure out what improvement action will Somewhere along our path we seem to have forgotten produce the best result. It also makes call review, the improvement part of quality improvement. So how protocol compliance monitoring, and pre-billing review do we put the missing ‘I’ back into Quality fast and easy. With FirstPass you can let the computer Improvement? do the initial review of all of your calls, saving your staff for the things computers can’t do. Improvement success comes from making the Model for Improvement a regular part of the EMS organization, and it comes from effectively measuring your efforts. In these EMS organizations, the principles and practices associated with the science of improvement have been integrated into their DNA. They monitor their FirstPass does performance data in all vital areas of their operations, not only tell you How does it work? so they are able to spot problems before they get out when a call is FirstPass provides continuous monitoring of ePCR and of control. other data. It quickly reviews each call based on your flagged because specifications and flags calls for review when based on the There is no one right process or theory for how to ePCR something is amiss, clinical issues, urgent patient do this, but we must expose and train our it did not meet safety issues, or missing data elements. employees to these ideas in order to make Automate protocol, but it improvement thinking automatic. We cannot We offer a standard bundle of FirstPass protocols simply say “we will now be a performance performance also tells you including ACS/STEMI, Stroke, Trauma, Airway improvement oriented organization.” measurement so WHY the call Management, Cardiac Arrest, and Universal. All of At FirstWatch it is our goal to help provide you with the you can focus on flagged. these or other protocols that you’d like to monitor will tools to help your organization and employees become what matters be customized to meet your needs. successful, improvement oriented systems, and to also help you understand how our FirstWatch real-time, most - your Each of your FirstPass protocols feeds data into a dashboard that displays all of your system performance on quality improvement tools can fit into your patients. organization’s overall Quality Improvement program. one constantly updating page. The display allows you to The next time someone asks you those “What have you see how you’ve performed over time for the things that improved lately” questions, you can answer with matter most. With one click you can drill into each protocol confidence, and data! to see the performance of all of the sub components that make up a protocol. This allows you to fine-tune your - Mike Taigman, FirstWatch Improvement Guide performance improvement efforts like never before. 2 The traditional approach to Quality Improvement in EMS is labor intensive, time consuming and often confusing, leaving little time to actually improve care. EMS agencies What is need the ability to monitor and analyze patient care data, identifying deviations rapidly, consistently and FirstPass? automatically. FirstPass® is a Performance Improvement system that makes it easy for you to see your systems overall performance for clinical care and billing. It helps you quickly identify big areas that need improvement and then helps you figure out what improvement action will produce the best result. It also makes call review, protocol compliance monitoring, and pre-billing review fast and easy. With FirstPass you can let the computer do the initial review of all of your calls, saving your staff for the things computers can’t do.

FirstPass does not only tell you How does it work? when a call is FirstPass provides continuous monitoring of ePCR and other data. It quickly reviews each call based on your flagged because specifications and flags calls for review when based on the it did not meet ePCR something is amiss, clinical issues, urgent patient protocol, but it safety issues, or missing data elements. also tells you We offer a standard bundle of FirstPass protocols including ACS/STEMI, Stroke, Trauma, Airway WHY the call Management, Cardiac Arrest, and Universal. All of flagged. these or other protocols that you’d like to monitor will be customized to meet your needs.

Each of your FirstPass protocols feeds data into a dashboard that displays all of your system performance on one constantly updating page. The display allows you to see how you’ve performed over time for the things that matter most. With one click you can drill into each protocol to see the performance of all of the sub components that make up a protocol. This allows you to fine-tune your performance improvement efforts like never before.

3 CEM AN E H N N T FirstPass v3 Interface E

M O DULE The FirstPass Dashboard has run charts or control charts that display your system’s performance to your protocols over time. This makes it easy to see if the training, protocol change, or other improvement you’ve implemented resulted in actual improvement. These charts make it easy for your team to know where to focus your quality improvement efforts.

Drill down into charts for a view of individual test performance.

4 CEM AN E H N N T FirstPass v3 Interface E

M E FirstPass makes it easy to see how an individual provider’s performance compares O DUL to their previous performance and the system overall for each individual test.

The FirstPass gives you the ability to send direct feedback to crew members regarding a specific call.

5 FirstPass Standard Reports FirstPass Standard Reports

Provider Protocol Compliance Summary of Tests by Protocol Display compliance of protocols and compare them against the system for the same This displays the system protocol compliance. When the protocol is expanded, the time frame selected. Individual tests can be selected to view the incidents used for individual protocol test information and compliance is displayed. When expanded, this compliance reporting. displays the protocol and the associated tests with their system-wide compliance.

Expand Provider Name to view compliance to individual test within each protocol

6 FirstPass Standard Reports

Summary of Tests by Protocol This displays the system protocol compliance. When the protocol is expanded, the individual protocol test information and compliance is displayed. When expanded, this displays the protocol and the associated tests with their system-wide compliance.

7 FirstPass Standard Reports

Protocol Compliance Graph This is a graphical representation of the tests for each protocol. The bar graph can be clicked to provide a detailed summary of all incidents that failed a particular test within a protocol. Drill through the graph to display incident information for each incident that failed within a protocol.

Drill-down:

8 FirstPass Standard Reports

Protocol Summary Report Provides a count of incidents and displays the raw pass and count percentage as well as the adjusted pass count and percentage of incidents in FirstPass. Adjusted refers to incidents that were reviewed and found to have passed due to predetermined exception criteria.

9 FirstPass Standard Reports

Call Review Status Report This report displays which incidents in FirstPass have been assigned to individual reviewers and displays how long they have been in the queues for review. It is designed to track the time an incident is assigned in FirstPass and includes each of the users which can review incidents.

10 FirstPass FAQs

How is FirstPass different from FirstWatch? FirstPass is an add-on, enhancement module that sits on top of FirstWatch. FirstWatch is the foundation for which the data is derived, where you define the things you want to look at and calls are pulled based on user-defined filters. FirstPass then takes that data through a very structured process of algorithms and logic to evaluate specific quality oriented protocols, tests and outcomes. A queue based tool, FirstPass allows members of QI, risk management and the medical director’s office to all access and work through one singular quality improvement tool.

Can FirstPass be customized to fit my system’s protocols? Providing that the data source (CAD, ePCR, ProQA, Hospital Data etc.) FirstWatch is interfaced with captures relevant data that can be used to evaluate against your systems protocols, FirstPass can have a high degree of customization. Once a customer defines what they want to measure, we can build custom protocols that look for quality metrics driven by customer focused initiatives as well as regional or state level mandates. While FirstPass is highly customizable, we recommend starting with our “Bundle of Care” approach. This initial set of evidence-based protocols is designed to encompass recognized standards of care, the affordable care act and overall best practices. The Bundle of Care is made up of the following protocols: ACS/STEMI, Stroke, Trauma, Airway Management, Cardiac Arrest, and Universal OR Billing. Additional metrics to consider might be: Pain Management, Patient Care Aspect, High Risk/Low Frequency Event or Non Transports/Refusals.

How will my QI department benefit from using FirstPass? The overarching goal of FirstPass is to provide automated data analysis for clinical indicators and quality measures – all in real-time, at your fingertips. With FirstPass, QI teams can now spend more time working to improve patient outcomes rather than filtering through every patient record to locate potential outliers that could indicate opportunities for improvement in patient care. FirstPass automates a process that is traditionally time, resources and labor intensive; you will now know right away when a call is outside the expected parameters occurs. Real-time feedback and knowledge of what is happening within your system at all times allows for collaboration amongst crew members, managers, QI analysts, the Medical Director and any other stakeholders involved. Ultimately, this will result in rewarding success to crew members for a job well done and improving patient outcomes by focusing on areas of improvement and continuing education in a timely and continuous manner. Additionally, FirstPass comes with real-time reporting tools; examples include Provider Protocol Compliance, System Protocol Compliance and Summary of Test by Protocol.

How is FirstPass connected to Healthcare Reform and the new focus on Quality Outcomes? Healthcare is moving to quality measurement, bringing with it improved patient care – and financial implications. Simply stated, the components of the Affordable Care Act are directly related to controlling cost through a focus on quality of care. The same quality measures that are driving change in healthcare will soon be coming to EMS. Progressive EMS agencies are monitoring, measuring and managing quality to improve patient care and ensure success when financial incentives become realities. FirstPass helps agencies to define, automate and streamline their measures and monitor in a timely, consistent and reliable manner. This will allow systems to make corrections and demonstrate timely and effective care through the tracking of patient satisfaction and outcomes in real-time. 11 Customer Highlight: Pinellas Customer Highlight: Metro Atlanta Ambulance Service

Pinellas County employee Provider Protocol Compliance report compares employee Metro Atlanta uses FirstWatch and the FirstPass Quality Improvement (QI) module to compliance to overall system compliance, including their raw and adjusted protocol monitor our ZOLL Dispatch and ePCR data, which automatically scans those records compliance percentages. and compares them to goal times and clinical, operational and billing rules. The graphic below shows the FirstPass module’s main screen, with queues (on the left) showing calls that have passed or flagged a series of detailed, automated tests, based on their medical director’s specific protocols.

QI reviewer works through a queue of calls that need human review, within minutes of the call...

Using FirstPass, Pinellas County has dramatically improved their performance over time. The graphic below shows the specific tests that are automatically performed by FirstPass for their Chest Pain protocol. Their QI staff reviews the calls that were flagged and is able to provide feedback to crews quickly, often during the same shift, while the call is still fresh in their mind.

12 Customer Highlight: Metro Atlanta Ambulance Service

Metro Atlanta uses FirstWatch and the FirstPass Quality Improvement (QI) module to monitor our ZOLL Dispatch and ePCR data, which automatically scans those records and compares them to goal times and clinical, operational and billing rules. The graphic below shows the FirstPass module’s main screen, with queues (on the left) showing calls that have passed or flagged a series of detailed, automated tests, based on their medical director’s specific protocols.

QI reviewer works through a queue of calls that need human review, within minutes of the call...

The graphic below shows the specific tests that are automatically performed by FirstPass for their Chest Pain protocol. Their QI staff reviews the calls that were flagged and is able to provide feedback to crews quickly, often during the same shift, while the call is still fresh in their mind.

13 Customer Highlight: Metro Atlanta Ambulance Service

Calls where the treatment was appropriate, but not documented as expected, can be identified and marked as appropriate, and the adjusted pass/fail information is reflected in our Employee Scorecard Report, along with simpler Operations measures, including: Chute Time, Response Time, Scene Time, Hospital Offload Time, and Task Times.

Employee Scorecard

The Employee Scorecard is a custom report that combines operational performance (chute times, time on task, etc.) as well as clinical performance (FirstPass protocol compliance) and displays it by medic. The summary page is the first page of the report and shows the overall system compliance for all elements. It is designed to be paged by provider for feedback purposes, and uses both CAD and ePCR data.

14 Customer Highlight: Metro Atlanta Ambulance Service Customer Highlight: Metro Atlanta Ambulance Service

Calls where the treatment was appropriate, but not documented as expected, can be Billing in FirstPass identified and marked as appropriate, and the adjusted pass/fail information is reflected in our Employee Scorecard Report, along with simpler Operations measures, including: Chute Time, Response Time, Scene Time, Hospital Offload Time, and Task Times.

Employee Scorecard

What’s the quality of your billing? Do you know your organization’s compliance in obtaining your needed billing information? The Employee Scorecard is a custom report that combines operational performance (chute times, time on task, etc.) as well as clinical performance (FirstPass protocol Can you get your billing compliance) and displays it by medic. The summary page is the first page of the report compliance at the field and shows the overall system compliance for all elements. It is designed to be paged employee level? by provider for feedback purposes, and uses both CAD and ePCR data. If you create a billing protocol in FirstPass, you will!

15 “By using FirstPass, our team has saved a minimum of 20 hours You have the a week by reviewing only those charts flagged as needing to be reviewed. FirstPass has created significant efficiencies for us data. Now what KEY BENEFITS with a long term annual savings of a half FTE.” • Real-time Automated Performance Improvement - use ~ FirstPass User, Tony Sorensen, Life EMS you need is a way one tool to monitor protocol compliance, to understand documentation, and improvement success what it means • Measure Protocol Compliance - prioritize and monitor the protocols that are most important to your system quickly and • Enhance Documentation Quality - real-time review of confidently. completion of required ePCR fields • Provide Meaningful Feedback - ask questions and provide medics with feedback before they end their shift HEMSI Medics “We use our FirstPass billing protocol everyday. We love it • Save Time & Resources - Let the computer do the because it saves us both time and money. Without FirstPass, we work, and save the human for what is most important would definitely need to hire an additional full time employee just to keep up with reviewing more than 50,000 ePCR records • Monitor Medic Performance - Track individual Life EMS Quality Team Member Reviewing Flagged per year. I don't know what we would do without FirstPass!” Calls in real-time for follow-up with crews performance to overall system objectives ~ FirstPass User, Jon Howell, HEMSI

Live Sites ® A look at FirstPass by the Numbers... 130 120 110 100 91+ 13.4Million + 570+ 3,290+ Million409+ 14+ 90 80 Live Sites Records Protocols Tests Tests Run ePCR System 70 (Plus 30 Processed Interfaces in process) 60 50 40 30 1 3 /2 years in research and development 20 10 0

6/2010 7/2011 11/2011 Additional 1/2014 6/2015 3/2016 5/2018 12/2018 Started developing Initial SCCAD FirstPass development FirstPass FirstPass Mike Taigman joins FirstPass 91+ Live FirstPass with records Trademark customers Version 1 Version 2 FirstWatch as Version 3 Sites St. Charles County processed Registration released at released Improvement Guide released Ambulance District accepted NAEMSP (SCCAD) 7/2015 1/2017 3/2018 2019 Projected FirstPass processed FirstPass processed FirstPass processed In process 16 1 millionth record 5 millionth record 10 millionth record “By using FirstPass, our team has saved a minimum of 20 hours You have the a week by reviewing only those charts flagged as needing to be reviewed. FirstPass has created significant efficiencies for us data. Now what KEY BENEFITS with a long term annual savings of a half FTE.” • Real-time Automated Performance Improvement - use ~ FirstPass User, Tony Sorensen, Life EMS you need is a way one tool to monitor protocol compliance, to understand documentation, and improvement success what it means • Measure Protocol Compliance - prioritize and monitor the protocols that are most important to your system quickly and • Enhance Documentation Quality - real-time review of confidently. completion of required ePCR fields • Provide Meaningful Feedback - ask questions and provide medics with feedback before they end their shift HEMSI Medics “We use our FirstPass billing protocol everyday. We love it • Save Time & Resources - Let the computer do the because it saves us both time and money. Without FirstPass, we work, and save the human for what is most important would definitely need to hire an additional full time employee just to keep up with reviewing more than 50,000 ePCR records • Monitor Medic Performance - Track individual Life EMS Quality Team Member Reviewing Flagged per year. I don't know what we would do without FirstPass!” Calls in real-time for follow-up with crews performance to overall system objectives ~ FirstPass User, Jon Howell, HEMSI

6/2010 7/2011 11/2011 Additional 1/2014 6/2015 3/2016 5/2018 12/2018 Started developing Initial SCCAD FirstPass development FirstPass FirstPass Mike Taigman joins FirstPass 91+ Live FirstPass with records Trademark customers Version 1 Version 2 FirstWatch as Version 3 Sites St. Charles County processed Registration released at released Improvement Guide released Ambulance District accepted NAEMSP (SCCAD) 7/2015 1/2017 3/2018 2019 Projected FirstPass processed FirstPass processed FirstPass processed In process 1 millionth record 5 millionth record 10 millionth record 17 e billing team would then review the report to identify documen - tation issues related to reimbursement. Like most departments, RAA performed these focused PCR reviews because trying to review every PCR provides a limited return on a significant investment of manpower and resources. Either several reviewers read the reports with little consistency or guidance on what to look for, or one person attempts to review every PCR but eventually gets so far behind they scramble to catch up and can’t provide effective feedback to providers or correct documentation errors in time to impact billing. Practitioners often didn’t receive the feedback until several weeks after the call, when they might not even remember the patient. In Richmond, agency leaders felt the process wasn’t as effective as it could be. ey began searching for other solutions, and found one right in their own headquarters. In the dispatch center, supervisors had already seen how technology HORIT Y

AU T could provide real-time feedback and lead to improvements. At any time during the day, dispatchers can look at a monitor that shows whether

BULANC E they’re meeting certain performance standards. RAA uses FirstWatch, a California-based data and technology ﬁrm, to monitor computer-aided dispatch (CAD) data and provide almost instant analysis. In the dispatch center, that has helped drive improvements in areas like call processing times, where no dispatcher wants to be the one not AWRENC E/ RICHMON D AM meeting the goal that day. RO B L

ES Y On the clinical side, RAA recently began using FirstPass, a tool developed by FirstWatch to automatically evaluate PCRs for adherence COUR T to protocols. FirstPass works by running each PCR through a series of HOT O P tests based on certain criteria as soon as the data is available. e tests are based on treatment bundles and tailored to the agency’s protocols. e software also compares each PCR to a universal protocol that checks reports for certain demographic and basic clinical data, such as baseline vital signs, signatures and other information RAA wants to collect for every patient. Richmond Ambulance Authority uses operations, the chief clinical officer, the quality Certain types of reports are screened further. For example, if the manager, the director of reimbursement, the patient complaint is for chest pain or another cardiac-related problem, technology to enhance its QA/QI process compliance officer and the operations and FirstPass will look for documentation of a 12-lead ECG. If none is communications supervisors. documented, the incident is flagged. For chest pain patients, FirstPass By Michael Gerber, MPH, NRP and Rob Lawrence, MCMI Believing that each aspect of agency per- will also look for appropriate documentation of specific treatments, formance is connected and part of the cycle such as aspirin or nitroglycerine administration. FirstPass’s clinical ichmond, Va., Ambulance Author- might mention a specific documentation issue of providing high-quality services, RAA uses care bundles are evidence-based but also tailored to RAA’s protocols ity (RAA) is well known for being a that’s causing delays in billing or collections. its TQM approach to measure and analyze and training. RAA is also working with the FirstPass team to develop high-performance EMS system and e chief clinical officer may discuss intu - outcomes and processes and make adjust- even more sophisticated analysis and reporting tools. for its community education efforts and imple- bation rates and educational programs being ments to training and policies to achieve its R THE TQM PROCESS mentation of a culture of safety. implemented to improve them. desired outcomes. But the agency has also recently taken a huge e idea behind TQM is that everything When paramedic and RAA’s QA/QI Director of Operations Tom Ludin leap forward in the areas of quality assurance is interconnected. Dispatch and operations USING TECHNOLOGY arrives each morning, he checks to see which reports were flagged by (QA) and quality improvement (QI). RAA, impact clinical care, clinical documenta- TO FILL THE GAPS the FirstPass system. He can immediately review the PCR to deter- which serves as the sole provider of emergency tion impacts reimbursement, reimbursement Previously, RAA’s clinical and documenta- mine if it was a documentation error, an omission in patient care or if ambulance service for the Virginia capital, has impacts operations, and so on. Like many tion QI process focused on reviewing specific there was a reasonable deviation from protocol. If the answer isn’t clear, implemented the “Total Quality Management” agencies, RAA has a clinical services com- types of patient care reports (PCRs), such he can talk to the crew who treated the patient first to help make his (TQM) system. e system links quality man- mittee that focuses solely on clinical issues, as all cardiac arrests; specific high-risk, low- decision while the crew still recalls the details of the call. agement efforts in the clinical, operations and where the medical director is joined by the frequency procedures (e.g., cricothyrotomy); “It gives a lot of opportunity to look through and see where improve- billing arenas in order to comprehensively clinical officer, the QA/QI coordinator, the and a certain percentage of other calls. e ments are needed,” says Ludin. “We can’t fix it if we don’t know it’s improve RAA’s service and efficiency. training staff and other paramedics. But the agency also would choose to review specific a problem.” Each month, RAA’s TQM commit- TQM meeting adds another layer. topics or themes during certain months— FirstPass not only allows for every PCR to be reviewed for at least tee meets to discuss any potential areas for Attendees at the TQM meetings include perhaps looking at reports written by new hires minimal criteria, it also creates a system for measuring overall perfor- improvement. e director of reimbursement the chief operating officer, the director of one month and field training officers the next. mance of the agency and individual providers. In many systems, simple For more information, visit JEMS.com/rs and enter xx. 58 JEMS | JULY 2015 WWW.JEMS.COM WWW.JEMS.COM JULY 2015 | JEMS 59

18 e billing team would then review the report to identify documen - tation issues related to reimbursement. Like most departments, RAA performed these focused PCR reviews because trying to review every PCR provides a limited return on a significant investment of manpower and resources. Either several reviewers read the reports with little consistency or guidance on what to look for, or one person attempts to review every PCR but eventually gets so far behind they scramble to catch up and can’t provide effective feedback to providers or correct documentation errors in time to impact billing. Practitioners often didn’t receive the feedback until several weeks after the call, when they might not even remember the patient. In Richmond, agency leaders felt the process wasn’t as effective as it could be. ey began searching for other solutions, and found one right in their own headquarters. In the dispatch center, supervisors had already seen how technology could provide real-time feedback and lead to improvements. At any time during the day, dispatchers can look at a monitor that shows whether they’re meeting certain performance standards. RAA uses FirstWatch, a California-based data and technology firm, to monitor computer-aided dispatch (CAD) data and provide almost instant analysis. In the dispatch center, that has helped drive improvements in areas like call processing times, where no dispatcher wants to be the one not meeting the goal that day. On the clinical side, RAA recently began using FirstPass, a tool developed by FirstWatch to automatically evaluate PCRs for adherence to protocols. FirstPass works by running each PCR through a series of tests based on certain criteria as soon as the data is available. e tests are based on treatment bundles and tailored to the agency’s protocols. e software also compares each PCR to a universal protocol that checks reports for certain demographic and basic clinical data, such as baseline vital signs, signatures and other information RAA wants to collect for every patient. Certain types of reports are screened further. For example, if the patient complaint is for chest pain or another cardiac-related problem, FirstPass will look for documentation of a 12-lead ECG. If none is documented, the incident is flagged. For chest pain patients, FirstPass will also look for appropriate documentation of specific treatments, such as aspirin or nitroglycerine administration. FirstPass’s clinical care bundles are evidence-based but also tailored to RAA’s protocols and training. RAA is also working with the FirstPass team to develop even more sophisticated analysis and reporting tools.

THE TQM PROCESS When paramedic and RAA’s QA/QI Director of Operations Tom Ludin arrives each morning, he checks to see which reports were flagged by the FirstPass system. He can immediately review the PCR to determine if it was a documentation error, an omission in patient care or if there was a reasonable deviation from protocol. If the answer isn’t clear, he can talk to the crew who treated the patient first to help make his decision while the crew still recalls the details of the call. “It gives a lot of opportunity to look through and see where improvements are needed,” says Ludin. “We can’t fix it if we don’t know it’s a problem.” FirstPass not only allows for every PCR to be reviewed for at least minimal criteria, it also creates a system for measuring overall performance of the agency and individual providers. In many systems, simple For more information, visit JEMS.com/rs and enter xx. WWW.JEMS.COM JULY 2015 | JEMS 59

19 7/27/2017 Improve EMS performance like a champion TOTAL QUALITY MANAGEMENT

database searches and spreadsheet computa- entire agency helps find a solution. is will coordinators instituted a system-wide effort tions can determine how often 12-lead ECGs become even more critical for EMS agen- to improve—even though they knew not every are documented as having been performed on cies when the next revision of the Interna- single paramedic had unsuccessful intubations. chest pain patients. But FirstPass creates an tional Statistical Classification of Diseases In the Login Room, they set up intubation easy way to then track why that happened. On and Related Health Problems (ICD-10) is manikins and equipment, as well as some lit- EMS Topics Paramedic Chief Articles a continuous basis, supervisors can determine adopted by payers later this year. erature and videos on airway management. whether providers require re-education in clin- With ICD-10, the number of billing codes At the beginning of each shift, every ALS ical areas, documentation, or both. will greatly expand, and the importance of provider took 10 minutes to practice intu- “Ninety-nine percent of the calls pass the cri- good documentation will increase. Having a bation before heading out on the ambulance Better EMS Performance teria. I never look at most of those,” says Ludin. TQM program is helping RAA prepare for to run calls. with Mike Taigman After Ludin reviews a PCR that failed a these changes by bringing billing and clinical After the recent intubation refresher sta- FirstPass test, he decides whether there was services to the table together. When the billers tions, RAA’s training staff received positive a deviation from protocol or a documentation find an issue with documentation, they can ask feedback from the providers, including one error and emails the provider who wrote the the clinical supervisors about it and determine paramedic who credited the training with help- report within one business day. at provider if it’s a documentation error or a misunder- ing make his first live intubation successful. Improve EMS performance like a then has a chance to review the call and explain standing by the billers over what service was RAA was also an early EMS adopter of what happened, or correct the PCR, and Ludin actually provided. If systemic problems are self-reporting. Several years ago, operational and his colleagues determine whether any discovered, the clinical supervisors can con- medical director Joseph Ornato, MD, signed champion further action—such as remedial training— duct training or change the minimum required off on a self-reporting protocol that encour- is required. information to complete a PCR. ages providers to come forward when they But while FirstPass allows RAA to check make an error or omission. Learn how one EMS agency improved EMS provider performance with each PCR for certain criteria, it doesn’t replace CLOSING THE QI LOOP But this isn’t to say that RAA doesn’t let having a real person dedicated to QA/QI. RAA keeps its quality management as nonpu- providers know they value high performance. an Olympic-themed competition “FirstPass is a tool,” Ludin says, explaining nitive as possible, focusing instead on finding Each year when employees submit prefer- that he still uses his own database queries and ways to motivate its staff to make corrections ences for which shifts they want to work, RAA Jan 6, 2017 other methods for other aspects of the quality and solve problems. Just publicly displaying ranks them using a combination of seniority management process. some performance measures, either at the indi- and compliance to certain standards. With For example, Ludin reads a random selec- vidual level or system-wide level, has led to FirstPass now in effect, that might include tion of PCRs each month so he can look for improvements. Clinical lapses aren’t necessarily compliance to clinical protocols and PCR any issues the computer might not catch. As tied to performance evaluations, unless super- documentation in the future. an accredited dispatch center, RAA already visors feel there are no efforts made to improve. By Mike Taigman and Tony Sorensen reviews the 9-1-1 calls for critical cases and a “You’re not evaluated on your QA/QI THE FUTURE OF QA/QI random selection of other calls each month— results,” Ludin says. “Instead it’s your respon- Technology adds one more tool to the TQM My most vivid Olympic memory is the 1996 women’s gymnastics all-around competition. The Ludin uses the same list to determine which siveness to training.” process, allowing personnel to spend more Russians had dominated the sport and going into the final rotation it looked like it would be PCRs he will review. When it was recently discovered that intu- time doing what they do best—analyzing the Having a TQM system means that when bation rates were slipping after an influx of problems and finding solutions—instead of possible for the U.S. to win for the first time in Olympic history. The last U.S. event was the vault. issues are discovered by one department, the newly qualified paramedics, RAA’s training spending hours determining whether the right U.S. team member Dominique Moceanu had fallen twice when Kerri Strug, the last U.S. boxes were checked. Software can’t replace hav- competitor, lined up to vault. Strug under-rotated the landing of her first attempt and injured her ing dedicated providers and educators, but it ankle. can make the system more efficient and more robust, allowing agencies to focus on areas where improvement is necessary and ultimately With the point difference smaller than a blood cell, she asked the coach, "Do we need this?" provide better care for their patients. JEMS

Michael Gerber, MPH, NRP, is a paramedic, instructor, author He said, "Kerri, we need you to go one more time. We need you one more time for the Gold. You and consultant in Washington, D.C. He has more than a decade can do it; you better do it." of experience in EMS and the re service. He can be reached at mgerber@redashgroup.com. She limped to the end of the runway and then landed the vault on both feet long enough to Rob Lawrence, MCMI, is chief operating ocer at RAA and was named an EMS 10 Innovator for his work on the Rider Alert register a 9.712 before collapsing in pain, cementing the Olympic gold medal for the U.S. program in 2011. Rob is a graduate of the U.K.’s Royal Military Academy, Sandurst, and spent his rst career as an active-duty OLYMPIC INSPIRATION FOR EMS IMPROVEMENT Army ocer in the British Royal Army Medical Corps, after which he held various senior leadership roles in U.K. ambu- The TQM system links quality management e orts in the clinical, operations and billing arenas in order to lance services before moving to Richmond, Va., to join RAA. Inspired by champions like Strug, the team from Life EMS Ambulance, established in Grand comprehensively improve RAA’s service and eciency. Photo courtesy The RedFlash Group/RAA Rapids, Mich. in 1980 and proudly serving over 3,700 square miles of west Michigan with

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EMS Topics Paramedic Chief Articles Better EMS Performance with Mike Taigman

Improve EMS performance like a champion Learn how one EMS agency improved EMS provider performance with an Olympic-themed competition

Jan 6, 2017

By Mike Taigman and Tony Sorensen

My most vivid Olympic memory is the 1996 women’s gymnastics all-around competition. The Russians had dominated the sport and going into the final rotation it looked like it would be possible for the U.S. to win for the first time in Olympic history. The last U.S. event was the vault. U.S. team member Dominique Moceanu had fallen twice when Kerri Strug, the last U.S. competitor, lined up to vault. Strug under-rotated the landing of her first attempt and injured her ankle.

With the point difference smaller than a blood cell, she asked the coach, "Do we need this?"

He said, "Kerri, we need you to go one more time. We need you one more time for the Gold. You can do it; you better do it."

She limped to the end of the runway and then landed the vault on both feet long enough to register a 9.712 before collapsing in pain, cementing the Olympic gold medal for the U.S.

OLYMPIC INSPIRATION FOR EMS IMPROVEMENT

Inspired by champions like Strug, the team from Life EMS Ambulance, established in Grand Rapids, Mich. in 1980 and proudly serving over 3,700 square miles of west Michigan with https://www.ems1.com/paramedic-chief/articles/158461048-Improve-EMS-performance-like-a-champion/ 1/6

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paramedic response, decided to have some fun and see if they could make some meaningful improvements at the same time. Their theory was that if they focused on a handful of measurable opportunities for improvement, added in a dose of friendly competition, and o ered prizes for the winners, that they would make meaningful improvements.

Their quality improvement-focused version of the Olympics was held last summer in the months before, during and after the Rio Olympics. The Life EMS Ambulance organization is naturally segmented into three teams — central, north/east, and south — for friendly competition. They created four events:

1. Vital Sign Sprint: Did we obtain two sets of vital signs on each patient? 2. Breath Stroke: Did we use capnography on patients receiving ventilatory assistance? 3. Last Normal Backstroke: Did we record the last seen normal time for patients with CVA? 4. Data Sync Dive: Was the data from the monitor uploaded into the ePCR?

Their aim was to make tangible improvements in these four areas. Baseline data provided a starting point. The company provided feedback on team performance every two weeks in company newsletters. Individual employees got regular feedback on their performance through FirstPass, a clinical quality measurement and protocol monitoring tool. Gold medal winners got $25 gift cards, silver got a pizza party and bronze got an ice cream social.

A spirit of camaraderie, competition and fun spread throughout the organization. Crew members started coaching each other on ways to improve.

SIGNIFICANT AND SUSTAINED PERFORMANCE IMPROVEMENT

Life EMS Ambulance saw signifcant and sustained improvement in two of the target areas. These two charts are Shewhart charts, which are a type of statistical process control charts to display data for performance improvement.

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The other two target areas saw no change. They had no decrease in performance anywhere in their system. And probably the most surprising thing is that they saw widespread sustained improvement in several areas that were not on the target list. These included improvements to:

Time to 12-lead ECG acquisition.

Time to nitroglycerin administration and time to aspirin administration for patients with acute coronary syndrome.

Recording of two pain scores.

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ROSC for people with cardiac arrest.

Temperature and ETCO2 assessed for possible sepsis patients.

7 PERFORMANCE IMPROVEMENT LESSONS

The team at Life EMS ambulance learned valuable lessons about quality improvement that are applicable to any EMS agency. Here is what they learned:

1. A friendly competition focused on quality improvement can result in improvements. 2. These improvements appear to be sustainable, at least in the few months after the competition ended. 3. Not everything that is focused on for measurement will improve with the rst eort. 4. Providing regular feedback, close in time to the actual patient care, to the team and individuals on performance helps people keep on track. 5. Focused improvement in a few areas has the potential to overow and cause improvement in other areas. 6. It’s possible to have a lot of fun while engaged in serious improvement work. 7. A dedicated and talented team of front line medics are able to implement widespread improvements in a short period of time.

There are some performance improvement theorists that suggest competition might not be a good idea — that competition has the potential to erode self-esteem, especially in young people. The leadership team addressed this concern by ensuring that 80-90 percent of the focus was on improving care for their patients with a lighthearted playful sense of competition.

Other experts will tell you the use of rewards like prizes undermines the joy in work. Their theory is that when people are too focused on the prize they might actually care less about the work they are doing and any improvements will be short lived. For this competition, the prizes were not luxury Caribbean cruises or fancy sports cars. Prizes were modest, but real. And we know that the prizes were not the primary focus, because the improvements have sustained well past the awarding of gift cards, pizza and ice cream.

Who could possibly top the Olympics? Bond. James Bond. Yes, their next quality improvement competition will have a 007 theme. The target areas will be:

Serial 12 lead EKG’s … One is not enough.

Pain scores are forever.

Doctor Know … for base physician contact.

Morphine and fentanyl weight-based dosing … for your weight only.

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Trauma scene time … license to live.

About the co-author Tony Sorensen is the vice president of resource performance for Life EMS Ambulance and a paramedic I/C with 31 years of EMS experience in both rural and urban systems. In addition to his EMS clinical experience he has taught MFR, EMT, EMT-S and paramedic programs through Montcalm County EMS, Montcalm Community College and Life EMS Ambulance. Tony is active in https://www.ems1.com/paramedic-chief/articles/158461048-Improve-EMS-performance-like-a-champion/ 5/6

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many local, regional and state level EMS activities. He is the past president of the Society of Michigan EMS Instructor Coordinators and the current president of the Michigan EMS Practitioners Association. Tony also represents MiEMSPA as a member of the State of Michigan EMS Coordination Committee. He has held leadership positions with Montcalm County, State of Michigan EMS Section as the EMS Education Coordinator.

About the author GROU P

Mike Taigman uses more than four decades of experience to help EMS leaders and eld personnel AS H improve the care/service they provide to patients and their communities. Mike is the Improvement REDF L

Guide for FirstWatch, a company which provides near-real time monitoring and analysis of data COURTES Y along with performance improvement coaching for EMS agencies. ZABO N/ JA MES He holds a Master’s Degree in Organizational Systems and is an Associate Professor in the HOT O Emergency Health Services Management graduate program at the University of Maryland P Baltimore County. He’s also the facilitator for the EMS Agenda 2050 project. Email Mike Taigman at mtaigman@ rstwatch.net.

Tags EMS Advocacy • EMS Management • Leadership

Pinellas County (Fla.) EMS implements an In 2014, the clinical leaders from each of the 19 organizations, and Angus Jameson, e ective QI process MD, their new EMS medical director, decided that they wanted to transform their quality By Mike Taigman & Michael Gerber, MPH, NRP improvement (QI) system into one that’s truly patient-centered, inclusive, comprehensive, as your quality improvement func- departments providing ALS first response respectful of all providers and free from fear. tion actually made anything better? and Sunstar Paramedics, the contracted ALS ey began by building trusting relation- e honest answer for many EMS ambulance service. ships through transparency, open sharing of Hsystems is, “No.” For those that can say yes, ese agencies, along with the Pinellas data, and implementation of Just Culture, better documentation is often cited as their County EMS and Fire Administration and defined by the Center for Patient Safety as evidence—not the kind of improvement that the EMS medical director, work together an organizational culture that “supports open inspires thank you letters and cookies from in a unique way that delivers real benefit communication of errors in a non-punitive grateful patients. to patients. environment.”1 (See Table 1, page 43.) e EMS system in Pinellas County, Getting nearly 2,000 EMS clinicians on To help facilitate the process, the Pinellas Fla., is one that’s made measurable clinical the same page about providing consistent, team turned to FirstPass, software that was improvements to the care that’s provided to high-quality care is remarkable and doesn’t created by data analytics organization First- their patients and their community. happen by accident. Watch. e software allows them to mon- Its success can be credited to deep col- Since 2008, Pinellas County EMS providers itor the care delivered and documented on laboration between more than 1,800 front- had been using electronic patient care reports more than 200,000 EMS calls a year, pro- line EMTs and paramedics working in 19 (PCRs) and manually tracking performance vide feedback and coaching to each EMT and different organizations across this western indicators. A few years later, they looked for paramedic in near real-time, and improve over- Florida coastal community: 18 municipal fire ways to automate and improve the system. all performance.

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26 GROU P AS H REDF L COURTES Y ZABO N/ JA MES HOT O P

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27 Table 1: Just Culture matrix used to guide individual and systemwide improvement e orts.

Human Error At-Risk Behavior Reckless Behavior

Root cause is at-risk behavior by a cli- Root cause is human error or inadver- Root cause is a conscious disregard of nician where the risks was unrecog- tent action—oversight, lapse substantial and unjusti able risk by nized or believed to be insigni cant or mistake. a clinician. or justi ed.

Improvement E orts Improvement E orts Management

Individual/Team: Individual/Team: Individual/Team:

>> Quality assurance review >> Clinical restriction (case basis) >> Clinical restriction or suspension >> Medical case review >> Quality assurance review (case basis) >> Remedial training >> Medical case review >> Quality assurance review >> Remedial training >> Administrative proceeding >> Corrective action plan System: System: >> Probation >> Revocation of clinical privileges >> Continuing medical education >> Supporting culture expects >> Protocol improvement healthy behaviors, corrects and >> Situational awareness minimizes at risk behaviors >> Best practices implementation >> Continuing medical education >> Patient care safety systems >> Situational awareness >> Process improvement >> Medical equipment & supply Note: Repeated at-risk behavior is improvements reckless.

Console Coach Correct

Management of individual quality assurance reviews or medical case reviews is based upon this framework. A owchart for Just Culture implementation and decision making is contained in the EMS medical director’s Medical Quality Management Plan to ensure the proper application of the framework on a case-by-case basis.

SELECTING A QI PROJECT on scene,” even when crews had been with the measures and baseline data in detail. Para- One of the challenges in the Pinellas system is patient for more than 15 minutes. medics were also provided detailed examples having a large number of organizations, each A protocol existed for managing patient of how to manage a variety of different situ- with its own leadership structures and policies. refusals, but providers frequently didn’t fol- ations involving patient refusal of transport. An important piece of the county’s EMS low it and there was wide variation across the In addition, the team defined performance QI system is a written Medical Quality Man- county in how these patients were handled. measures for patient refusals and designed a agement Plan that clarifies the roles of the To address the issue, Jameson collabo- communication plan to share information with county medical director and the roles of the rated with all clinical leaders on an update the entire system. individual departments. to the Pinellas County EMS refusal protocol e measures were built into their First- In addition, prior to implementation, each that included curr ent legal perspectives. e Pass QI system so that PCRs from every non- organization made sure to communicate clearly performance improvement team also began transport would be checked for compliance the purpose of FirstPass and what it was being working to build trust with each provider with their guidelines within seconds of sub- used to look for—and why. ,noitazinagro rieht lacinilc sredael dna rieht mission of the report. e automated system For example, one of Pinellas County EMS’s frontline paramedics. checked each report using these criteria: first improvement projects focused on patient With a strong commitment to a non- >>Was the patient’s final Glasgow coma score interacti ons that didn’t result in transport to punitive approach, they collaborated and 15? the hospital. is was chosen after Jameson worked hard to demonstrate a focus on improv- >>Were two sets of vital signs recorded? and others noticed that the county had a rel- ing care for patients, rather than punishing >>Was a chief complaint documented? atively high refusal rate and the documen- providers. ey made their expectations crystal >>Was the patient’s history, medications, and tation of this potentially risky decision was clear and were very transparent with system- allergies documented? often minimal. wide and department-level performance data. >>Was a witness signature obtained? Many of the patient care reports simply Before they started providing performance >>Was the narrative greater than 150 stated, “No ambulance needed,” or, “Cancelled feedback, they reviewed all of the quality characters?

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28 A CULTURE OF QUALITY

Figure 1: PCR agged by QI software

The patient care report in this case was agged because it was missing a second set of vital signs. You can also see that this paramedic documents two sets of vital signs and at least one Glasgow coma scale 81.48% of the time, while the entire system meets this criterion 86.43% of the time.

>>Was their “decisional capacity” described in the narrative? e 150-character test was designed to address the providers’ tendency to write a three-word narrative as the only description on calls where crews had spent significant time with patients. “Deci- ro ot tnesnoc ot enoemos fo ytiliba eht sebircsed ”yticapac lanois ”yticapac sebircsed eht ytiliba fo enoemos ot tnesnoc ot ro refuse care. Paramedics in Pinellas County were also trained to conduct a comprehensive EMS Cognitive Evaluation that could be used to help FIRE & EMS BLOGGERS determine if a patient has the decisional capacity to refuse transport. ALL IN ONE NETWORK! REVIEWING PAST PERFORMANCE At the beginning of the improvement project, Pinellas County performed a baseline analysis of the system’s past performance based on these criteria and found that overall adherence to the guidelines was low, hovering around 10%. On some individual criterion within the bundle of care—narra- tives longer than 150 characters, acquiring witness signatures, a final Glasgow score of 15, and documenting chief complaint, history, meds, allergies—performance exceeded 80%. But field providers were obtaining two sets of vital signs less than 10% of the time and “decisional capacity” was described in the PCR less than 20% of the time. Analyzing this earlier data allowed the medical director and 19 organizations to focus improvement efforts on the two parts of their refusal bundle that needed the most attention. e FirstPass system automatically reviews all PCRs for compliance to the appropriate protocols, including refusals. (See Figure 1) www.fireemsblogs.com e Pinellas County EMS system produces thousands of patient refusal PCRs each month. When one or more of the seven criteria For more information, visit JEMS.com/rs and enter 21. listed previously aren’t met, the report is flagged for review by the

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29 appropriate individual within the PCR author’s department—often quality assurance system that only looks for mistakes and slaps pro- the EMS supervisor or quality improvement manager, depending on viders on the wrist, has also allowed for evaluation not just of adher- the organization’s policies. ence to clinical protocols but also whether those protocols are, in fact, Because the PCRs are reviewed by the software immediately, feed- the best for the system. back and coaching can be pro- at goes not only for vided while the call is still fresh refusals, but for other patient in the minds of the EMTs and care bundles being continu- paramedics. Because the PCRs are reviewed ously assessed in the system, In addition, the compliance including cardiac arrest, major with the entire bundle and by the software immediately, trauma, acute coronary syndrome eb nac airetirc eht fo hcae htiw hcae fo eht airetirc nac eb and others. measured and tracked at the feedback & coaching can “Once we have the system individual, department and sys- reliably providing care in align- temwide levels. be provided while the call ment with the protocols and documenting it properly, it’s pos- COMMUNICATION is still fresh in the minds of sible to evaluate trends and really & FEEDBACK see how well the protocol is serv- Pinellas County also imple- the EMTs & paramedics. ing our patients,” Jameson said. mented a campaign to ensure “We fine-tuned our chest pain that each EMT and paramedic protocol to optimize recogni- in the system understood the clinical and legal risks associated with tion of STEMI faster and to better manage pain as early as possible.” patient refusals, how to conduct and evaluate a proper EMS cogni- By tracking performance over time, building a non-punitive tive evaluation, the rationale for obtaining two sets of vital signs, the just culture, using near real-time analysis tools, and having a truly importance of good documentation and the seven tests included in patient-centered, collaborative approach, the refusal bundle of care. the departments delivering EMS in Pinellas — Continued on page 62 e campaign was conducted via email, Facebook and newsletters, as well as in the classroom. Conversations about patient refusals were built into new employee orientation and field training officer programs. With Academy Analytics you can: “We didn’t just turn this system on full throttle overnight,” one • Monitor your center’s ProQA performance in real-time, from anywhere! EMS captain said. “We rolled it out over 18 months of planning and lots of beta testing. Full implementation felt for some people like we • Instantly identify outlier cases for review. went from 0 to 1,000 mph, but they have been impressed by how much • Provide teammates with a dashboard that shows how they are doing on the things that matter. improvement we’ve made so quickly.” • Know when there is an increase in aborted or overridden Once the campaign was well underway, the clinical leadership teams calls. began providing feedback to crews whenever a call was flagged in First- • Balance the workload to help manage employee stress. Pass. Each department handles the coaching and feedback process in • Coach your team to optimal performance. a way that works for them. One department prefers group emails and • Potentially increase the number of cardiac arrest patients communication over individual feedback, while another department that survive. schedules weekly one-on-one meetings with every medic on its team. Even though they customize the feedback process, all 19 departments provide feedback quickly and carry the same patient-centered non-punitive message; they also coordinate efforts with the county medical director and follow the same policies to determine when it is necessary to notify Jameson.

DRAMATIC RESULTS e results of their eﬀorts to improve care for patients who refuse transport have been dramatic (See Figure 2, p. 63.). “For the longest time, QA was viewed as the, ‘What have you done wrong today club,’” an EMS captain said. “With our change to Just Culture combined with the nearly instantaneous feedback facilitated by FirstPass, we can concentrate on what [we] are doing right. I send out a thank-you letter signed by the chief for every medic that has 100% performance on our clinical protocols. I used to send out 12 to 20 a month, now it’s between 170 and 180 a month.” www.prioritydispatch.net/academyanalytics Transitioning to a t rue quality management system, rather than a For more information, visit JEMS.com/rs and enter 22.

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30 A CULTURE OF QUALITY

— Continued from page 45 Figure 2: Pinellas County EMS compliance with patient refusal bundle of care County have the data to show some of the 100% biggest improvement their system has ever Percentage seen—and they’re just getting started. JEMS 80%

Mike Taigman focuses on making things better for EMS 60% patients, providers and systems. Mike is the Improvement Guide for FirstWatch, the facilitator of the EMS Agenda 2050 40%

project, and an associate professor for the EMS program at the Compliance 20% at mtaigman@ rstwatch.net. Michael Gerber, MPH, NRP, is a paramedic, instructor, author 0% and consultant in Washington, D.C. He has more than a decade of experience in EMS and re and serves as a life member with the Bethesda-Chevy Chase Rescue Squad. He can be reached at May 2016July 2016 May 2017July 2017 mgerber@redashgroup.com. March 2016 March 2017 January 2016 January 2017 SeptemberNovember 2015 2015 SeptemberNovember 2016 2016 SeptemberNovember 2017 2017 REFERENCE Reporting period 1. Just/Accountable Culture. (n.d.) Center for Patient Safety. Retrieved Dec. 11, 2017, from www.centerforpatientsafety.org/ Pinellas County EMS saw its compliance with the patient refusal bundle of care improve dramatically after just-culture/. implementing a focused quality improvement program.

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For more information, visit JEMS.com/rs and enter 26.

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31 Contact one of our team members today to learn more about our real-time, quality improvement tools.

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